Tag Archives: smoking

E-cig use stalls as health concerns grow

Use of electronic cigarettes and other vaping devices has stalled in the United States as more Americans question their safety, according to a new online Reuters/Ipsos poll.

About 10 percent of the 9,766 adults surveyed between April 19 and May 16 use the devices, the same percentage as in a similar Reuters/Ipsos poll in May, 2015.

This year, however, a growing percentage of participants expressed negative attitudes toward e-cigarettes. Forty-seven percent of respondents said vaping was not healthier than smoking conventional cigarettes compared with 38 percent who felt that way a year ago.

Forty-three percent said they did not believe vaping could help people quit smoking compared with 39 percent who held that view in 2015. A majority of participants — 66 percent – say that vaping can be addictive compared with 61 percent in 2015. Additionally, 49 percent said this year that it could have a similar effect to that of second-hand tobacco smoke compared with 42 percent last year.

The growing concerns about the devices could hit their already slowing sales, especially for smaller e-cigarette and vaping companies. Many of these brands have lost market share to big tobacco companies, such as Altria and Reynolds American Inc. Some do not expect to survive with new U.S. rules to regulate the e-cigarette market.

“In some ways, a move away from e-cigarettes is actually positive for Altria and Reynolds,” said Morningstar analyst Adam Fleck, pointing out it may help sustain sales of conventional cigarettes, whose margins are much higher.

Sharra Morris, 42, a mental health counselor in Moore, Oklahoma, started using e-cigarettes in February despite some misgivings about their safety. She tried vaping to help her quit smoking regular cigarettes.

“The question now is: are they really safe?” said Morris, who likes to vape using liquids flavored to taste like Fruit Loops cereal and Snickerdoodle cookies. “What will they tell us in 20 years?”

E-cigarettes are metal tubes that heat liquids typically laced with nicotine and deliver vapor when inhaled. The liquids come in thousands of flavors, from cotton candy to pizza.

Use of the devices has grown quickly in the last decade, with U.S. sales expected to reach $4.1 billion in 2016, according to Wells Fargo Securities. Sales were down 6 percent in the first quarter of 2016, however.

The healthcare community remains deeply divided over the devices. Some healthcare experts are concerned about how little is known about the potential health risks. They are especially worried about rising teen e-cigarette use, and fear that may get a new generation hooked on nicotine.

Some support them as a safer alternative to tobacco smoke for smokers who have been unable to quit.

Dr. Michael Siegel, a professor at the Boston University School of Public Health, has advocated vaping as a way to wean smokers off conventional cigarettes. He blames negative publicity for the growing concerns about the devices, and believes most are unwarranted.

“There have been public health scares, and they are working,” said Siegel. “They are dissuading a lot of people from trying these products.”

CHANGING ATTITUDES

The U.S. Food and Drug Administration issued its first rules regulating e-cigarettes earlier this month, banning their sale and advertising to minors and requiring that manufacturers submit their products for approval.

At least one lawsuit has been filed in response to the new rules and more are expected. Many smaller companies say the testing requirement is too burdensome because it will cost hundreds of thousands of dollars per product, and they often manufacture dozens. They say the rules favor the large players, such as Altria and Reynolds.

Companies selling in the United States are banned from marketing the products as smoking cessation devices. About three-quarters of people who switch between e-cigarettes and traditional cigarettes said in the Reuters/Ipsos survey they tried them to quit conventional cigarettes, but still smoke tobacco “on occasion.”

Many are like Michael Whittaker, a 47-year-old delivery driver from Halifax, Massachusetts, who took up vaping a few months ago. “I figured it might be better for me and I might smell better.”

Now he is trying to cut back on both, which is common for dual users.

About 80 percent of people who switch between e-cigarettes and traditional cigarettes said they vape “in places where regular cigarettes are prohibited,” such as public buildings, or “when I’m near people who don’t like tobacco smoke.”

About half of those who currently vape or said they used e-cigarettes in the past said friends and family encouraged them to try the devices. The Reuters/Ipsos poll has a credibility interval, a measure of its accuracy, of plus or minus 1.1 percentage point for all respondents and 5.6 percentage points for questions asked of people who switch between conventional and e-cigarettes.

A concern for healthcare professionals is that while 29 percent of those who stopped vaping said in the poll they “quit all nicotine products,” almost half returned to conventional cigarettes.

Of those who went back to traditional tobacco products, 57 percent said they returned to conventional cigarettes because vaping was not satisfying, and 10 percent said it was not convenient enough. U.S.-approved smoking cessation products and strategies include medications, patches and counseling, many of which are now covered by insurance.

“We think there are certainly more and better ways to help smokers to quit,” said Erika Sward of the American Lung Association. “When you’re going to e-cigarettes, you’re not quitting, you’re switching,” she said.

(Reporting By Jilian Mincer; Editing by Michele Gershberg and Tomasz Janowski)

Enthusiast Brandy Tseu uses an electronic cigarette at The Vapor Spot vapor bar in Los Angeles, California March 4, 2014. The Los Angeles City Council voted unanimously on Tuesday to ban the use of electronic cigarettes, popularly known as "vaping," from restaurants, bars, nightclubs and other public spaces within the nation's second-largest city.  REUTERS/Mario Anzuoni
Enthusiast Brandy Tseu uses an electronic cigarette at The Vapor Spot vapor bar in Los Angeles, California March 4, 2014. The Los Angeles City Council voted unanimously on Tuesday to ban the use of electronic cigarettes, popularly known as “vaping,” from restaurants, bars, nightclubs and other public spaces within the nation’s second-largest city. — PHOTO: REUTERS/Mario Anzuoni

HUD seeks to snuff out smoking in housing

Public housing across the United States may go smoke-free in two years if a rule proposed by U.S. Housing and Urban Development takes effect.

The rule would require more than 3,100 public housing agencies to carry out policies prohibiting lighted tobacco products — including pipes, cigars and cigarettes — in living units, common areas, offices and outdoor areas within 25 feet of office buildings or housing.

HUD Secretary Julian Castro and Surgeon General Vivek Murthy announced the proposal earlier this year, opening a 60-day public comment period that ends this spring. “We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke,” Castro stated. “This proposed rule will help improve the health of more than 760,000 children and help public housing agencies save $153 million every year in health care, repairs and preventable fires.”

Cigarette smoking kills 480,000 people each year and is the leading preventable cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention.

Meanwhile, the U.S. Surgeon General has concluded there is no risk-free level of exposure to secondhand smoke and cleaning the air, ventilating buildings and separating smokers from non-smokers cannot eliminate exposure to secondhand smoke.

The only way to protect nonsmokers is to stop indoor smoking. A web of federal, state and local laws has extinguished indoor smoking in many places. Yet, 58 million Americans — including an estimated 15 million children — remain exposed to secondhand smoke, mostly at home.

HUD’s rule would impact more than 940,000 housing units, expanding on a voluntary campaign initiated by HUD in 2009. Over seven years, more than 600 public housing agencies — including at least 51 of the 123 housing authorities in Wisconsin — have adopted smoke-free policies for buildings and common areas. HUD estimates that more than 228,000 housing units already are smoke-free.

With a caution, the National Association of Community Health Centers supports the goals of the proposed rule. The association’s chief concern, said Colleen P. Meiman, director of regulatory affairs, is whether the rule would lead to increased homelessness.

“Smoking is an addiction,” Meiman said in her public comment to HUD. If the ban is implemented, she said any violations “should result in progressive action, starting with referrals to smoking cessation service” and “violations should never result in fines or eviction.”

In Wisconsin, advocates for the rule include fire chiefs, the Wisconsin Asthma Coalition in West Allis, American Lung Association in Brookfield, Westlawn Partnership for a Healthier Environment in northwest Milwaukee and the University of Wisconsin Center for Tobacco Research and Intervention.

The UW center cited a CDC study estimating that banning smoking in public and subsidized housing would save $310.48 million annually in health care costs associated with secondhand smoke, $133.77 million in costs for renovating and maintaining smoky apartments and buildings and $52.57 million in avoided fire damages.

The center encouraged HUD to expand the proposed rule to include e-cigarettes and other “electronic nicotine delivery systems,” with a reference to “growing evidence of carcinogenic and other harmful chemicals in e-cigarette liquid and vapor.

Many advocating a ban observed that secondhand smoke cannot be contained — that it travels through air leaks in ceilings, floors and walls.

The rule “has the potential to reduce health care costs, save lives and improve the quality of life for so many Americans,” according to Anne Dressel, project director for Westlawn Partnership for a Healthier Environment.

The partnership is a group of community stakeholders that has met regularly since 2008 to address health and environmental concerns at Westlawn, Wisconsin’s largest publicly subsidized housing development.

Dressel, in her comment on the proposed rule, said Milwaukee County ranks as the worst county in the state for asthma-related hospitalizations and emergency room visits. And the rate of asthma-related hospitalizations for children residing in the Westlawn community is about twice the county rate. The rate of emergency room visits for Westlawn is 1.5 times higher than the county rate.

 

Illinois medical marijuana sales start Monday

More than 3,000 patients with Illinois-issued ID cards will be able to buy medical marijuana legally for the first time on Nov. 9, according to the state official overseeing the pilot program.

Eight licensed dispensaries are authorized to start selling cannabis on that day, program director Joseph Wright told The Associated Press. The number will grow to a dozen dispensaries by the end of the month and up to 25 by the end of the year, Wright said.

More than two years after Illinois enacted its medical cannabis law, growers began shipping their products to dispensaries around the state, following instructions sent to them by the Illinois Department of Agriculture. A statewide digital tracking system has been launched to prevent any diversion of marijuana to the black market.

“It’s a safe industry with a strong infrastructure here in Illinois,” said Ben Kovler, CEO of Green Thumb Industries, which has started shipping marijuana from its Rock Island cultivation facility to its dispensary in Mundelein and other retail shops. “We’re all in touch with local police. There will be no surprises.”

Kovler cautioned patients that they must have their ID card and have designated a dispensary with the Illinois Department of Public Health before they can make a purchase. “I’d hate for somebody to drive and learn that at the end of the drive,” Kovler said.

Transportation from cultivation center to retail shop will be governed by official instructions sent to growers. They can transport marijuana only between 7 a.m. and 9 p.m. Vehicles carrying it must be staffed by at least two cultivation center employees.

Growers must enter unique product ID numbers into the system before they can ship. Florida-based BioTrack THC, which has the Illinois contract for tracking medical marijuana from seed to sale, has similar state contracts in Washington, New Mexico and New York, said CEO Patrick Vo.

In Illinois, BioTrack will be paid $230,000 to get the system running, with annual hosting and maintenance costs of $37,000, Wright said.

The tracking system allows state officials to monitor in real time the location of seedlings, sale products and even plant waste scheduled for destruction. “In the system, any change in quantity requires some type of action or description,” Vo said.

The system also is designed to catch violators who might add black-market marijuana to the legitimate system, Vo said. Tracking each product protects patients with weakened immune systems from marijuana that hasn’t been tested for harmful microbes, poisons from fungus, pesticides and solvents.

“I’m certain there are a lot of people on the fence” about Illinois’ pilot program “and people who are staunchly prohibitionist,” Vo said. “Accountability, transparency and safety are things both sides can get behind.”

Illinois has 3,300 patients approved for the program. The Illinois Department of Public Health started mailing patients their official program ID cards last week.

The eight licensed dispensaries are located in Marion, Mundelein, Canton, Quincy, Addison, North Aurora, Schaumburg and Ottawa.

Illinois is among 23 states with medical marijuana programs.

“We’re thrilled,” said Bradley Vallerius, spokesman for Revolution Cannabis-Delavan, a cultivation center in central Illinois, which plans to ship products to dispensaries this weekend.

Hot dogs, cold cuts and red meat classified as carcinogens

Bacon, hot dogs and cold cuts are under fire: The World Health Organization threw its global weight behind years of experts’ warnings and declared Monday that processed meats raise the risk of colon and stomach cancer and that red meat is probably harmful, too.

Meat producers are angry, vegetarians are feeling vindicated, and cancer experts are welcoming the most comprehensive pronouncement yet on the relation between our modern meat-eating lifestyles and cancer.

The WHO’s International Agency for Research on Cancer in Lyon, France, analyzed decades of research and for the first time put processed meats in the same danger category as smoking or asbestos. That doesn’t mean salami is as bad as cigarettes, only that there’s a confirmed link to cancer. And even then, the risk is small.

The results aren’t that shocking in the U.S., where many parents fret over chemicals in cured meats and the American Cancer Society has long cautioned against eating too much steak and deli.

But the U.N. agency’s findings could shake up public health attitudes elsewhere, such as European countries where sausages are savored and smoked ham is a national delicacy.

And they could hurt the American meat industry, which is arguing vigorously against linking their products with cancer, contending that the disease involves a number of lifestyle and environmental factors.

While U.S. rates of colon cancer have been declining, it is the No. 2 cancer for women worldwide and No. 3 for men, according to the WHO.

A group of 22 scientists from the IARC evaluated more than 800 studies from several continents about meat and cancer. The studies looked at more than a dozen types of cancer in populations with diverse diets over the past 20 years.

Based on that analysis, the IARC classified processed meat as “carcinogenic to humans,” noting links in particular to colon cancer. It said red meat contains some important nutrients, but still labeled it “probably carcinogenic,” with links to colon, prostate and pancreatic cancers.

The agency made no specific dietary recommendations and said it did not have enough data to define how much processed meat is too dangerous. But it said the risk rises with the amount consumed.

An analysis of 10 of the studies suggested that a 50-gram portion of processed meat daily — or about 1.75 ounces — increases the risk of colorectal cancer over a lifetime by about 18 percent.

An ounce and three-quarters is roughly equivalent to a hot dog or a few slices of bologna, though it depends on how thinly it is sliced.

Overall, the lifetime risk of developing colorectal cancer in the U.S. is about 1 in 20, or 5 percent, according to the cancer society. By the WHO’s calculations, having a cold-cut sandwich every day would only raise that to around 6 percent.

Experts have long warned of the dangers of certain chemicals used to cure meat, such as nitrites and nitrates, which the body converts into cancer-causing compounds. It is also known that grilling or smoking meat can create suspected carcinogens.

“For an individual, the risk of developing colorectal cancer because of their consumption of processed meat remains small, but this risk increases with the amount of meat consumed,” Dr. Kurt Straif of the IARC said in a statement. “In view of the large number of people who consume processed meat, the global impact on cancer incidence is of public health importance.”

The cancer agency noted research by the Global Burden of Disease Project suggesting that 34,000 cancer deaths per year worldwide are linked to diets heavy in processed meat. That compared with 1 million deaths a year linked to smoking, 600,000 a year to alcohol consumption and 200,000 a year to air pollution.

Doctors in rich countries especially have long counseled against eating lots of red or processed meat — and not just because of the cancer danger but because of the heart risks from the saturated fat and sodium.

The WHO researchers defined processed meat as anything transformed to improve its flavor or preserve it, including sausages, beef jerky and anything smoked. They defined red meat to include beef, veal, pork, lamb, mutton, horse and goat.

The report said grilling, pan-frying or other high-temperature methods of cooking red meat produce the highest amounts of chemicals suspected of causing cancer.

“This is an important step in helping individuals make healthier dietary choices to reduce their risk of colorectal cancer in particular,” said Susan Gapstur of the American Cancer Society, which has recommended limiting red and processed meat intake since 2002, and suggests choosing fish or poultry or cooking red meat at low temperatures.

The North American Meat Institute argued in a statement that “cancer is a complex disease not caused by single foods.”

Independent experts stressed that the WHO findings should be kept in perspective.

“Three cigarettes per day increases the risk of lung cancer sixfold,” or 500 percent, compared with the 18 percent from eating a couple slices of bologna a day, said Gunter Kuhnle, a food nutrition scientist at the University of Reading.

“This is still very relevant from a public health point of view, as there are more than 30,000 new cases per year” of colon cancer, he said. “But it should not be used for scaremongering.”

Doctors, industry locked in vape debate over youth use

Cool Vapes on Pittsburgh’s McKnight Road is in an average-looking storefront at the foot of Ross Park Mall, sandwiched between a bridal shop and a cellphone outlet.

Inside, the place bustles with customers peering into glass cases full of flavored liquid nicotine with names like Strawberry Cheesecake, Fruity Fun and Crunchberry. Buyers heat the liquids with battery-operated devices and inhale the vapor in a process known as vaping.

The store contains several prominently placed signs warning: “You must be 18 years old to make a purchase.”

Legally, Cool Vapes does not need the signs. Pennsylvania is one of four states without age restrictions for purchasing electronic vaporizers, e-cigarettes and liquid nicotine, according to the American Vaping Association, an industry trade group.

Still, most vape shop owners in Western Pennsylvania maintain a casual agreement not to sell to minors.

“Selling to kids under 18 doesn’t send a good message,” said Cool Vapes owner R.J. Marino. “It’s a personal decision, and I think most vape shop owners agree. But do I have that legal right? Absolutely, at least for now.”

Anthony Fricchione, owner of Villain Vape Shop, which has stores in Lawrenceville, Cheswick and Butler, agreed.

“You would be hard-pressed to go into a vape shop and find an owner selling to teens,” he said. “Our goal is to help people quit smoking. Selling to minors is the last thing we want to deal with _ we’re already battling so much.”

One of those battles is Gov. Tom Wolf’s proposed 40 percent tax on e-cigarettes and vaporizers. On a national level, the Food and Drug Administration might soon classify liquid nicotine as a tobacco product, which members of the vaping industry say will lead to overregulation, hidden costs and red tape that could put them out of business.

“This industry is under consistent attack,” said Greg Conley, president of the AVA. “It’s new technology and confusing to some, so they’d just like to altogether eliminate it. We’re dealing with the toxic legacy of the tobacco industry.”

A recent study by JAMA Pediatrics said teenagers who try vaping or e-cigarettes are more likely to turn to traditional cigarettes for their nicotine fix and become addicted smokers. Researchers from the University of Pittsburgh, Dartmouth University and the University of Oregon surveyed young people from across the country.

A U.S. Centers for Disease Control and Prevention study produced similar results and indicated e-cigarette use among middle and high schoolers tripled from 2013 to 2014.

“In many ways, it’s the perfect starter cigarette for teens. It comes in flavors like chocolate or mango,” said Dr. Brian Primack, director of Pitt’s Center for Research on Media, Technology and Health and lead author of the JAMA Pediatrics study. “It’s electronic, it’s cool-looking, and it’s new. The problem is nicotine is one of the most addictive chemicals known to humans. Once you get addicted, you run the risk of needing more in the form of a traditional cigarette.”

Critics believe the e-cigarette industry markets to younger users with sleekly designed vaporizers and flavored juices.

“As a parent of an 8-year-old son, this stuff really scares me,” said Dr. Anil Singh, director of the breathing disorders center at Allegheny General Hospital. “If used in the right way and regulated, I can see some potential benefit for adults trying to quit smoking. But with the flavors and tools, it’s a great way for hooking young people in. I’d say it’s pretty dangerous.”

Bill Godshall, executive director of Smokefree Pennsylvania, scoffed at the JAMA Pediatrics study. He pointed to a recent CDC study that indicates teen smoking is at an all-time low.

“Cigarette smoking among youths is plummeting every year, but they say vaping is a gateway?” he said. “C’mon. I can’t believe JAMA is pushing this theory.”

As school let out at Taylor Allderdice High School in Squirrel Hill on a recent afternoon, a few students lit cigarettes as they walked down Forward Avenue. Oskar Porter, 15, a sophomore who was not smoking, said it’s not uncommon to see students vaping.

“I think some of the kids do it to be edgy,” he said. “And they can get away with it easier in the bathroom or the back of a classroom.”

Porter said he’s unsure whether vaping is a gateway to cigarettes, as studies suggest.

“I’ve seen plenty of kids who both vape and smoke cigarettes,” he said. “I’m not sure one leads to the other. They’re both pretty common.”

Published via the AP member exchange.

Research: 48.5 percent of deaths from 12 cancers attributable to smoking

Researchers estimate that 48.5 percent of the nearly 346,000 deaths from 12 cancers among adults 35 and older in 2011 were attributable to cigarette smoking, according to an article published online by the JAMA Internal Medicine.

Researcher Rebecca L. Siegel of the American Cancer Society and coauthors provided an updated estimate because they note smoking patterns and the magnitude of the association between smoking and cancer death have changed in the past decade.

While smoking prevalence decreased from 23.2 percent in 2000 to 18.1 percent in 2012, some data suggest the risk of cancer death among smokers can increase over time, according to background in the study.

The authors used data from the 2011 National Health Interview Survey, the Cancer Prevention Study III and the pooled contemporary cohort. The National Health Interview Survey provides smoking prevalence estimates based on in-person interviews of a representative sample of U.S. adults and the other data sources ascertained smoking from self-administered questionnaires.

The study estimates that of 345,962 deaths there were 167,805 attributable to smoking cigarettes.

The largest proportions of smoking-attributable deaths were for cancers of the lung, bronchus and trachea (125,799, 80.2 percent) and larynx (2,856, 76.6 percent).

About half of the deaths from cancers of the oral cavity, esophagus and urinary bladder were attributable to smoking, according to the results, which were reported in a research letter.

“Cigarette smoking continues to cause numerous deaths from multiple cancers despite half a century of decreasing prevalence. … Continued progress in reducing cancer mortality, as well as deaths from many other serious diseases, will require more comprehensive tobacco control, including targeted cessation support,” the study concludes.

Wisconsin lawmakers to take up bill to ban vaping indoors

Wisconsin lawmakers are set to reignite conversations about whether vaping — using electronic cigarettes and other vapor smoking devices — should be included in Wisconsin’s smoking ban.

The ban took effect in 2010 and it outlaws smoking in all public indoor locations, including restaurants and bars.

But the ban does not currently apply to vaping, giving venue owners the right to decide whether or not to permit e-cigarettes.

Democratic Rep. Debra Kolste of Janesville says because the indoor smoking ban has been so successful, the bill seemed like common sense.

But the bill will face Republican opposition.

State Rep. Joel Kleefisch, a Republican from Oconomowoc, says he will introduce a bill to protect e-cigarettes from the ban.

Smoking in Wisconsin annually costs $3 billion in health care, $1.62 billion in lost productivity

Smoking in Wisconsin annually costs $3 billion in health care expenses and $1.62 billion in lost productivity, according to the 2015 “Burden of Tobacco in Wisconsin” study by UWM’s Center for Urban Initiatives and Research.

The total cost of $4.62 billion marks an increase of $100 million dollars from the last “Burden” report released in 2010. 

The report estimates that more than 7,300 people die annually in Wisconsin from smoking-related diseases — that’s 15 percent of all deaths among people aged 35 and older. 

“When it comes to the prevalence of cigarette smoking, however, Wisconsin has been making progress,” says Karen Palmersheim, an epidemiologist and lead author of the report. The adult smoking rate is now 18 percent, which is down 2 percentage points from 2012. “This is an all-time low for the state,” adds Palmersheim. “Fewer high school youth are smoking too, with a dramatic decrease from 33 percent in 2000 to 11 percent in 2014.” 

Experts attribute the drop in smokers to a combination of the state’s comprehensive tobacco prevention program, smoke-free workplace law, and higher cigarette taxes. 

“But the costs continue to increase because of the long-term, chronic conditions caused by smoking, especially among those who become addicted at a young age,” says Palmersheim. 

Most of those deaths each year are associated with cardiovascular and respiratory disease, and smoking-related cancers — 6,700 deaths, according to the report. But nearly 10 percent are deaths caused by exposure to secondhand smoke and smoking-related fires. 

“These numbers are still very sobering, given that these deaths are preventable,” says Palmersheim. “If we hope to improve the situation, it’s imperative that programmatic efforts continue to prevent kids from ever starting to smoke and help smokers quit. If the rate of smoking continues to go down, we should see the number of related deaths and health care costs go down too.” 

The research was supported by the Wisconsin Department of Health Services, Division of Public Health, Bureau of Community and Health Promotion, Tobacco Prevention and Control Program. 

On the Web

The report: https://www4.uwm.edu/cuir/ 

Adult smoking rate dips below 18 percent

A government report says the smoking rate for U.S. adults dipped below 18 percent for the first time last year.

That’s still about the same rate found in 2012, and translates to about 42 million smokers.

The U.S. Centers for Disease Control and Prevention released the findings earlier this week.

The nation’s smoking rate had stalled at around 20 to 21 percent, until it started dropping a bit a few years ago. In last year’s survey, 17.8 percent of adults described themselves as smokers.

Smoking is the nation’s leading cause of preventable illness. It’s responsible for the majority of lung cancer deaths and is a factor in heart attacks and a variety of other illnesses.

On the Web…

CDC report: http://www.cdc.gov/mmwr

Historic smoking report marks 50th anniversary

Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.

The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.

In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised and new restrictions were placed on where people could light up.

“It was the beginning,” said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.

It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the U.S. Some experts predict large numbers of Americans will puff away for decades to come.

Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.

The report’s bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader’s Digest in 1952, “Cancer by the Carton,” contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.

But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers’ lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.

It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.

In 1957 and 1959, Surgeon General Leroy Burney issued statements that heavy smoking causes lung cancer. But they had little impact.

Amid pressure from health advocates, President John F. Kennedy’s surgeon general, Dr. Luther Terry, announced in 1962 that he was convening an expert panel to examine all the evidence and issue a comprehensive, debate-settling report. To ensure the panel was unimpeachable, he let the tobacco industry veto any proposed members it regarded as biased.

Surveys indicated a third to a half of all physicians smoked tobacco products at the time, and the committee reflected the culture: Half its 10 members were smokers, who puffed away during committee meetings. Terry himself was a cigarette smoker.

Dr. Eugene Guthrie, an assistant surgeon general, helped persuade Terry to kick the habit a few months before the press conference releasing the report.

“I told him, ‘You gotta quit that. I think you can get away with a pipe — if you don’t do it openly.’ He said, ‘You gotta be kidding!’ I said, ‘No, I’m not. It just wouldn’t do. If you smoke any cigarettes, you better do it in a closet,”” Guthrie recalled in a recent interview with The Associated Press.

The press conference was held on a Saturday partly out of concern about its effect on the stock market. About 200 reporters attended.

The committee said cigarette smoking clearly did cause lung cancer and was responsible for the nation’s escalating male cancer death rate. It also said there was no valid evidence filters were reducing the danger. The committee also said — more vaguely — that the government should address the problem.

“This was front-page news, and every American knew it,” said Robin Koval, president of Legacy, an anti-smoking organization.

Cigarette consumption dropped a whopping 15 percent over the next three months but then began to rebound. Health officials realized it would take more than one report.

In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for anti-smoking public service announcements. Cigarette commercials were banned in 1971.

Still, progress was slow. Warner recalled teaching at the University of Michigan in 1972, when nearly half the faculty members at the school of public health were smokers. He was one of them.

“I felt like a hypocrite and an idiot,” he said. But smoking was still the norm, and it was difficult to quit, he said.

The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.

Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.

In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.

Experts agree that the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?

For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.

At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.

Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.

Donald Shopland finds that depressing.

Fifty years ago, he was a 19-year-old who smoked two packs a day while working as a clerk for the surgeon general’s committee. He quit cigarettes right after the 1964 report came out, and went on to a long and distinguished public health career in which he wrote or edited scores of books and reports on smoking’s effects.

“We should be much further along than we are,” the Georgia retiree lamented.